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Objective   This study aimed to evaluate variations in anterior condylar height (ACH) of the distal femur in varus knee osteoarthritis and evaluate the association between ACH and knee flexion.Design   Computed tomography (CT) images of 171 knees (143 patients; age 73.7 ± 8.3 years; 132 females, 39 males) with symptomatic primary knee osteoarthritis and varus alignment undergoing primary total knee arthroplasty, unilateral knee arthroplasty, or high tibial osteotomy were evaluated. Several other anatomic parameters were measured on CT or radiography. The ACH and knee flexion correlation was analyzed, and factors contributing to knee flexion were determined using multivariable regression analysis.Results   Medial ACH (mean, 8.1 mm; range, −2.8 to 19.9 mm) was smaller ( P &lt; 0.001) but more variable ( F = 1.8, P &lt; 0.001) than lateral ACH (mean, 10.7 mm; range, 3.6-18.3 mm). Medial ACH was moderately correlated with flexion ( r = −0.44, 95% confidence interval [CI], −0.55 to −0.32), whereas lateral ACH was weakly correlated ( r = −0.38; 95% CI, −0.50 to −0.25). On multivariable linear regression analysis of knee flexion, body mass index ( B [partial regression coefficient] = −1.1), patellofemoral Kellgren-Lawrence grade ( B = −4.3), medial ACH ( B = −1.2), medial posterior condylar offset ( B = 1.2), age ( B = −0.4), and varus alignment ( B = −0.6) remained significant independent variables (adjusted R 2  = 0.35).Conclusions   Wide variation and anteriorization of the anterior condyle of the distal femur was observed in advanced osteoarthritis, as an independent determinant of limited knee flexion.

High and Varied Anterior Condyle of the Distal Femur Is Associated with Limited Flexion in Varus Knee Osteoarthritis